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 B. NURSING HOME SURVEYSUnder the current statutory system, the Health Care Financing Administration (HCFA) contracts with state agencies to inspect nursing homes for compliance.(27) Federal officials then randomly reinspect at least five percent of the homes to verify the state surveys.(28) NHRA produced dramatic effects.(29) By 1996, the regulations had cut the use of physical restraints on nursing home residents in half; incidences of dehydration also decreased by fifty percent.(30) Despite these promising results, subsequent reports found many disturbing conditions.(31) Approximately forty percent of all HCFA-certified facilities repeatedly violated federal standards over the past four surveys, including critical aspects of patient care.(32) "[A] quarter of the nation''s nursing homes failed even to assess each patient''s needs or develop individual care plans"(33) and, at the time, "government data show[ed] more than 2/3 of [the nation''s] nursing homes d[id] not fully comply with federal standards."(34) Explanations for the survey results ranged from the "federal inspection guidelines were less than rigorous and enforcement had little teeth ... [because] ... the only fines were minimal("35) claims that the inspection process was too subjective. The primary federal remedy, to deny payment for new admissions after three months of noncompliance,(36) apparently did not suffice to reform the quality of nursing home care.(37) CareScout.com founder Robert N. Bua, an attorney and former nursing home administrator, recognized the consumer demand for comparative information on senior facilities. In 1996, Bua created the first nursing home ratings system that was featured in his book, The Inside Guide to America''s Nursing Homes: Rankings & Ratings for Every Nursing Home in America, published by Time Warner Inc., and widely used by eldercare professionals and insurance providers. CareScout.com launches its Web site with the goal of being America''s number one resource for making intelligent eldercare decisions. To obtain more information, you can visit CareScout.com. Nursing homes perform a vital function in the long-term care continuum by providing nursing care around the clock to the elderly and disabled,(1) By entrusting these institutions with society''s frailest members, the general population relies on government agencies and their regulations to ensure that the elderly receive quality care.(2) States expect quality care, but providers often lack the financial support and regulatory guidance. The ASUI was significantly correlated with [FEV.sub.1] percent predicted and [FEV.sub.1]/FVC. In addition, the measure was capable of differentiating patient groups of known disease severity. Similar results were demonstrated using physician-generated ratings of severity of asthma and an asthma disease severity rating system based on emergency medical service use, spirometry, and symptoms. ASUI scores produced a stair-step pattern of decreasing scores with increasing disease severity. Patients categorized as having mild disease according to the physician rating scheme scored the highest on the ASUI at 0.88 and were distinguishable from the groups with moderate and moderate-to-severe disease by 0.24 and 0.41 points, respectively. Patients with mild/ moderate, moderate, and moderate/severe disease were also distinguishable with a value of 0.30 separating the mild/moderate from the moderate/severe. This suggests the instrument is sensitive to subtle differences in disease severity, a characteristic necessary for responsiveness to change with treatment and meaningful cost-effectiveness studies. Further research is needed to quantify the responsiveness of the ASUI to clinically meaningful change. With Doctor-Finder.biz you can find and compare docotor's in your area! Check it out!
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